Plasma D-dimer can predict malignant brain edema after thrombectomy in noncardioembolic acute cerebral infarction.

OBJECTIVE

There is relatively little data on malignant brain edema (MBE) after mechanical thrombectomy (MT) in non cardioembolic acute cerebral infarction caused by anterior circulation large vessel occlusion. Our study attempts to investigate the incidence rate of MBE after successful MT of anterior circulation acute non cardioembolic cerebral infarction, the predictive effect of emergency preoperative plasma D-dimer and clinical prognosis of patients.

METHODS

One hundred eighty-six consecutive patients suffered from anterior circulation non cardioembolic acute cerebral infarction who received successful MT were selected. Clinical features, imaging examinations, laboratory tests and treatment characteristics of patients at admission were collected and analyzed.

RESULTS

Among 186 patients (aged 64.26 ± 11.62 years; male accounted for 75.81%), 30 cases (16.13%) developed MBE. MBE patients had a low 3-month good prognosis rate and a high mortality rate (P<0.001). After adjusting for confounding factors, ASPECT score at admission (OR=0.322; 95% CI 0.146-0.711; P=0.005), tandem lesions in the location of occluded vessel (OR=6.422; 95% CI 1.799-22.924; P=0.004), collateral circulation score (OR=0.343; 95% CI 0.139-0.845; P=0.020) and emergency preoperative plasma D-dimer (OR=1.155; 95% CI 1.004-1.329; P=0.044) were significantly related to MBE. The area under the ROC curve of predicting MBE using emergency preoperative plasma D-dimer was 0.706 (sensitivity 0.500; specificity 0.859).

CONCLUSION

Emergency preoperative plasma D-dimer is associated with MBE in patients with noncardioembolic acute cerebral infarction of anterior circulation after successful MT, although its predictive performance is modest. The presence of MBE reduces the chance of patients' neurological independence at 3 months after MT. These findings are preliminary and require validation in larger prospective studies.